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Old 05-05-2010, 09:01 PM   #1
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Which Way Will It Go?

New to the board, so thankful to have found it. I'll try to be brief, but it might not work. Any help, advice, prior experience you can share would be great.

I have fibromyalgia, was dx'ed 15 years ago, been on Norco 5mg and Soma for 8 years. Was on 7.5 3X a day about 8 months ago, requested 5mg 4X a day. I am being treated by an osteopath, and have been going to the same one for 3 years, since I moved to the area. He is not really comfortable with narcotics, but since I had been on them for 5 years prior to seeing him, and provided med rcrds from previous osteopath, he started writing scripts for me on my 2nd month visit. I have never asked for an early refill. At most, I went in at 3 wks, not waited until 4wks, because my pain was very intense. Dr gave me scripts, then asked on my next visit (at the 30 day time frame) if I was burning through meds. I have a PM contract on file with him. Even though I do take more than prescribed (5-6 instead of 4/day), I just suck it up the last few days of the month, and deal with only having 2/day. I did not ask permission from him to take more than 4/day, and thus far, I have not told him.

On Tuesday, I went to urgent care for severe back pain. It was after my dr's office closed. I did not put on the paperwork about my current dr or the meds I'm on. I've been to urgent care for a stomach flu, and they asked me a hundred questions related to pain meds. I did not want to be treated like drug seeker, so I did not indicate that I was already being treated for fibromyalgia. When the urgent care dr came in, he examined me, then looked at a printout and asked me if I usually get Norco and Soma from Dr X. I said yes. He said that he could write me for a few, but not alot. I had told the dr when he came in the room that I was taking tylenol and advil for my pain. He asked me if I had an appt with my dr, and I said no, so he wrote me a script for 10 of each med as a stop-gap until I could see my dr. I said whatever you think is best. When the PA came in with the scripts, I asked her to get the dr please. I explained to the dr why I didn't put my meds on the intake forms, and he nicely informed me about laws and such. I told him he could take the scripts back as it's what I have anyway, but he said it was fine. I did not fill the scripts.

Today, I called my dr, and I'm pretty sure the urgent care dr called there. They had to get my chart and asked me why I needed an appt. I said because I went to urgent care and need to talk to him about that, and I might need a longer appt.

I will tell my dr about what happened at urgent care, and also remind him that I've had a tough few months with pain, and it needs to be addressed. At this point, I'm ready to stop taking the Norco, because I'm not comfortable that there might be an idea that I was trying to be deceptive.

What are the chances that he will just dismiss me because of the PM contract, or that he will be decent enough to give me some Norco to wean off of it (tmrw is my appt and it will be day 23 of a 30 day script), or that he will see that I am in greater pain than my meds is treating and he will increase my dose (maybe he will have empathy and appreciate my honesty)? I'm scared to be without the pills, because I haven't been in 8 years, and although I wasn't taking a huge amount of mgs, I am certain I will have withdrawals. I'm leaning toward a more aggressive dr, but the pain meds and muscle relaxer are the only meds I've been able to tolerate out of all the ones tried.

Any advice you can give for me on how to say, what to say, etc during my dr appt would be appreciated. I'm scared, nervous, worried, annoyed that he didn't up my dose when I told him I was in severe pain (and he could feel the tightness in my muscles), and just hoping to either get a second chance or something that will help my pain better.

Thanks for reading and helping!
FibroPainsMe
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And so do those who question my pain.
Walk a mile before you judge for a second.

 
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Old 05-06-2010, 11:12 AM   #2
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Re: Which Way Will It Go?

If you are REALLY lucky, he will keep you on with just a stern warning, but I wouldn't make a bet on it, especially if he finds out that you are taking more than prescribed. First, you lied on the form at the doc in a box. That will be seen as delibertly witholding information-probably as a means to seek stronger meds. And if he is as hesitant to prescribe as you say....that might be the end of it.

I don't understand why you didn't tell the urgent care you were under contract for pain management? It can only be held against you that you didn't share that up front. You said that you didn't want to be seen as a drug seeker which is why you didn't tell them about your contract and meds. That is what drug seeks do...they DON"T TELL ABOUT WHAT THEY TAKE OR THAT THEY ARE ON CONTRACT. You just sort of shot yourself in the foot..which is what the er doc thought also I bet.

I had an extremely bad flare up while we were in Japan on vacation over Christmas seeing our son. I ended up going into the ER on the Navy base(we're retired military). The first thing I did was to tell them that I was under contract with my pm doctor and on these meds. It made all the difference. I think by not self proclaiming, you are standing a good chance of being denied.

I hope that you get to continue with your doc, but if you do, you need to be honest with him because some day you are going to trip yourself up and that will be the end of it.

BTW the ER doc wouldn't up your dose after you told him what you were on. Not after you told him you were on contract for Pain Management. He won't go against another doctors orders.....

Last edited by ibake&pray; 05-06-2010 at 11:15 AM.

 
Old 05-06-2010, 11:53 AM   #3
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Re: Which Way Will It Go?

I probably should've been upfront, and I will be with my doctor. I just didn't want to be treated like I had been before when a dr sees what meds I was on. It's kind of like damned if you do, maybe even more damned if you don't...

I agree, I probably shot myself in the foot.

Thanks for your advice and feedback.
FibroPainsMe
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Walk a mile before you judge for a second.

 
Old 05-06-2010, 01:13 PM   #4
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Re: Which Way Will It Go?

Hey there Fibro- Welcome to the community.

IBake&pray brought up some very valid points. I ditto everything she said.

You see, medical staff at urgent care are going to form their own opionions, whether right or wrong, regardless of whether you tell the truth about current meds being taken or not- however- it's ALWAYS best to be honest and up front about any medications you are taking, what doctor is prescribing them and what kind of pain contract you are required to follow. This way, even if they do decide to form an opinion about whether you are a seeker or not, your conscience is clear. You see what I'm saying?

I too had to go to the ER with some issues and from the very get-go I let them know that I am currently being treated by a PM doctor. I even brought the medications that I take into the ER with me so they could see I am not a seeker. I was fortunate that they did not decide to think I'm a seeker. I think being honest and having my current meds with me helped a lot.

The one thing you do have going for you is that you did not fill the scrips the urgent care doctor wrote for you. Had you done that you could expect to be dismissed immediately when your doctor found out about it.

With what you have said, it is very possible that the urgent care contacted your doctor when they pulled you scrip/pharmacy records/history and found you were not up front about the meds you are taking. That doctor may have thought that you giving the scrips back was your way of doing "damage control" because of a guilty conscience, you know? I'm not saying that's what you were doing, but with the dishonesty and all, it's not suprising a doctor who doesn't know you from adam would assume this.

May I ask what other medications you have tried for your fibro issues? I ask because it seems to me that the Norco 4 times a day isn't really much as far as treating true, chronic pain. Norco is on the lower end of the pain meds ladder.

Has your osteo doctor tried other forms of treatment along with medications? If so, what has he suggested, and what kind of help did you get from those other treatments? Sorry for all the questions. I'm just trying to get a full picture here.

I think that seeing your doctor, being honest about what has happened and doing it face-to-face is your best option here. What he will choose to do, I can't even venture to guess. Most doctors will immediately terminate any patient for violating the rules of the contract.

Maybe you should ask him about the possibility of him refering you to an actual PM doctor? If he is already leary of narcotic medications, this situation will certainly be an easy out for him, you know?

Maybe he can refer you to a true PM doctor who will be able to treat your fibro. PM doctors are trained specifically in the treatment of chronic pain, so you would probably be better served in that regard.

Hope this helps a little. Good luck, and please let us know how it turns out, ok?

Take care.

 
Old 05-06-2010, 02:03 PM   #5
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Re: Which Way Will It Go?

Thank you for your reply. I understand everything you're saying. My only excuse is the pain was intolerable...a friend referred me to a PM dr here, and I have an appt Mon.

I see my osteo in about an hour. I will be honest with him about everything.

I appreciate your questions - it means you are trying to help.

I'm only on the Norco 5/325 4X/day and Soma 2-3X/day. I also have Valium 10mg for the really bad nights when I can't sleep. My meds seem to work when I am not stressed or overdo it, but not with any kind of flare-up, and I wasn't comfortable telling my dr that, because he kept talking about a PM dr, and my last experience with one was horrific. I was kind of dealing with it, for the sake of not having another bad PM dr experience. Over the past 15 years, I tried every antidepressant, SSRI, etc, even Lyrica, and I couldn't tolerate any of them. It was either my stomach, or my head feeling more foggy than usual, or I couldn't concentrate, or sometimes all 3. I was on Norco 7/5/325, but the dr dropped me to 3 a day, and because I need a 4th dose sometimes to be able to sleep, I asked him to drop me back to 5mg 4X/day.

I do stretching when tolerable, and massage when I can tolerate it. Sometimes a massage leaves me in pain for days too. I can't do much physical activity right now, because I ache for days...it's just not worth it to me. I think, though, that if I can get the pain under control, and not have the constant aching in my ribs, back, neck, knees, and hips that I could break this pain cycle, and exercise which would help me eventually not need as much pain medication.

I've never gotten high off of it, at all. I've been taking it 8 years, no increases in dose. I take it for pain only. At this point, I'm ready to throw in the towel, and stop pain meds all together. If I can't be upfront about something, it's because someone has given me a reason not to be, and I feel like if I take away that reason, yes...I will suffer in pain, but I won't be in situations like this.

I'm frustrated...and tired of being in pain.

Thanks again for your post.
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And so do those who question my pain.
Walk a mile before you judge for a second.

 
Old 05-06-2010, 03:31 PM   #6
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Re: Which Way Will It Go?

I know how you feel. I was diagnosed with fibro a few years ago, and although I didn't like what I heard, it DID help to know there was an explanation for the pain I was having. I have other issues too that have been diagnosed & treated for much longer.

I totally understand about adverse reactions from the different meds. Cymbalta is a great medication and really helps with the pain of fibro and my nerve damage too, but it raised my blood pressure to the point where I could have had a stroke. I've had bad reactions to several other meds as well, and my PM doctor has been able to confirm & document all of them, except for the sleepwalking that Ambien caused me. He couldn't actually confirm that since he doesn't live with me...haha.

I still say that because this current doctor is so leary about prescribing certain meds, there is only so much help he's going to be able to offer you. He's made that obvious.

I really hope the PM doctor will be able to help you. Fibro is still a very misunderstood condition because right now, there are no actual medical tests to diagnose it. It's diagnosed with a process of elimination and through symptoms you know? This is where PM doctors are helpful. They are always more privy to some of the lesser understood conditions, therefore more equiped to help those who suffer from them.

I know with my fibro stress is a HUGE factor in a flare up. Cold temperatures too. There are days that my hair hurts my head and I can't even run a brush lightly over my hair. Heck, I'm still learning things about this mysterious disease. It's amazing how many aspects of your daily life Fibro can and does effect! Sleep patterns? Yep- affected by Fibro. Well, we all know that sleep, good & restful sleep is imperative for body restoration, yet when you have chronic pain from any condition, you can't get a good nights sleep. It becomes almost like a snowball effect. Before you know it, you are in an unrelenting and unbreakable pain cycle.

Please let us know how it goes. And I thank you for not taking my post as an offense. I wasn't being judgemental, I just sometimes can't really give helpful information without seeing the whole picture.

Best of luck today, and for Monday

PS- I understand what you said about horrid PM experiences as well. Many of us have some horror stories....myself included...I won't go into details in your thread though.

Last edited by ozzybug; 05-06-2010 at 03:33 PM.

 
Old 05-06-2010, 05:10 PM   #7
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Re: Which Way Will It Go?

Just got home from the dr's. My blood pressure was sky high, my pulse was through the roof! I have no poker face. Anyway, the dr came in and asked how I was doing, and I said it depends on how this conversation goes.

I told him I might have done something that I shouldn't have and I'm very upset, uncomfortable, and nervous. He said "how many extra did you take?".

I was honest with him about taking more than prescribed per day, and I told him about the urgent care visit, why I went, and why I didn't indicate my meds on the forms. I told him I should've come to him, but I was afraid of what would happen. I handed him the script from urgent care, and he looked at it and handed it back to me. He said they only gave you 10 of each, and then he said "this isn't a copy, is it? did you even get this filled?" I said no, and he kind of smiled. He looked at the PM contract, and said "I think we understand each other, and this is the first time something like this has happened, but are we going to do this again?" I said "absolutely not". And he said "come to me when you have issues like this because I know your pain better than anyone. I'm going to write you for 6 extra days of meds. that will cover you for the 5 days you will be short this month and a few extra." (SHOCKING, right?!) I thanked him, apologized again, and told him I was so uncomfortable about this, and I came in to see him as soon as I could. He reiterated to come to him, and he looked again at my chart. He decided to put me on one of the oxy's (15mg 2x/day), no more Norco, continue Soma. He said to call him Monday to let him know how it's working, and to come and see him if it wasn't working for me. He even looked up the long acting meds to see if my insurance would cover them and at what level, and he let me choose the Tier 1 med.

I am completely in shock at how awesome he was about this. He's a really nice person anyway, but his level of compassion and understanding floored me. I should've given him the benefit of the doubt and gone to him. It's my own fibro-related anxiety that made me think twice about doing so...never again.

Thanks, all, for your advice, honest feedback, and being interested in what happened.

In shock,
FibroPainsMe
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And so do those who question my pain.
Walk a mile before you judge for a second.

 
Old 05-06-2010, 07:38 PM   #8
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Re: Which Way Will It Go?

Glad it worked out for you. It's nice to hear a good ending to one of these stories for a change. You just got your one and only get out of jail free card.

Take care,

bullymom

 
Old 05-06-2010, 08:47 PM   #9
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Re: Which Way Will It Go?

Very true. He made it clear to come to him with any pain issues, and he would adjust my dose. Perhaps I misjudged his level of willingness to up my dose if necessary. He was impressed with my honesty, and thanked me for it.

Have a great night!
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And so do those who question my pain.
Walk a mile before you judge for a second.

 
Old 05-07-2010, 08:38 AM   #10
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Re: Which Way Will It Go?

That's great! What a relief. This is one time where honesty proved to be the best policy. I think you and your Dr. are on a different level now and at a different place as patient and dr. For whatever reason, what you did has brought out his better side and it has brought out a trust for you from him (did that makes sense?).

You are gonna be alright....just don't stray off the yellow brick road!

Last edited by ibake&pray; 05-07-2010 at 08:39 AM.

 
Old 05-07-2010, 09:09 AM   #11
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Re: Which Way Will It Go?

Fibro- I too am really glad this worked out for you. There are very few stories of this nature that don't end with the patient being dismissed.

It's a good thing to be honest, and it appears your doctor truly appreciated your coming in and speaking with him face to face. Again, I also say that not getting those scrips filled played a huge role in his willingness to give a one time pass.

I understand your fears of requesting med changes due to continued pain issues, I think most of us feel the same way. We are forced to live in constant fear of scrutiny and being released from care because of those people who are seekers/abusers of their meds. We pay the price for their mistakes and rule breaking, and although it's not fair, that's the way it is.

I'm so glad it worked out for you and that you can now feel more comfortable talking with your doctor when your pain levels aren't being managed!!

Take Care,
Ozzybug

 
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